QUESTION: I have employer insurance coverage, but Medicare is saying I have to sign up for Part B. What do I do?

Medicare Part A, B and D have different rules. This article applies to the rules regarding Medicare Part B only.

Your current situation is: you are working, you carry insurance from your employer with Medicare Part A only. Medicare works hard to notify those eligible for Medicare to get signed up in an appropriate manner. Medicare sent you that letter because you only have Part A and they are reaching out to inform you about the GEP and the rules relating to Part B coverage.

For those individuals who have only Medicare Part A, Centers for Medicare and Medicaid Services (CMS) mails a letter to state that you may need to sign up for Medicare Part B. The General Enrollment Period (GEP) runs from January 1 to March 31 each year. The GEP is appropriate for those individuals who failed to sign up for Medicare Part B when they should have. If you missed your previous opportunity to sign up for Medicare Part B, you can sign up now during the Annual GEP and your Medicare Part B will begin 7-1-21.

For those individuals who turned 65 and are working, and/or covered by your (or your spouses) employee’s insurance, you can enroll in Medicare A and refuse Part B because you have insurance from another source. (When your employee group is larger than 20 employees and you are over 65 or larger than 100 employees if you have Medicare due to a disability).

You made the correct decision for your situation. If/When you lose your employee or spouse’s employee coverage, you should enroll in Medicare Part B immediately.

Once you stop working, or decide to drop the employee coverage you have a Special Enrollment Period (SEP) to sign up for Medicare Part B. You will need to complete the required paperwork to enroll in Medicare Part B. When Part B begins you will pay the Medicare Part B premium ($148.50 per month for most enrollees).

Some individuals don’t make that transition smoothly, because they don’t sign up for Medicare Part B in a timely manner (eight months from when your coverage ends).

If you go more than 8 months without Part B coverage and no insurance from another employment source, you will have limited opportunities to sign up for Part B. For Medicare Part B the GEP is from January 1 to March 31 each year. When you enroll using this GEP your Part B starts July 1.

Part B would then have a premium penalty, 10% for each 12 months lacking coverage. That penalty of 10% is based on the current Part B premium (10% of $148.50) and lasts for the rest of your life.

Some reasons people miss this enrollment in Medicare Part A & Part B is because they have insurance through work, or COBRA (Consolidated Omnibus Budget Reconciliation Act) or Retiree plan or a MarketPlace Plan. These last three reasons are NOT reasons to delay Part B. If you are carrying COBRA, or Retiree insurance or a MarketPlace Plan you MUST enroll into Medicare. There may be a reason to stay with these plans, but you still need Medicare Part A & B.

Some individuals are offered insurance at a lower cost or no cost to them when they first leave work, so they keep this insurance and then don’t sign up for Medicare Part B. If you aren’t going to work for the company that provides the health insurance to you, you need to have Medicare A & B.

The letter you received from CMS was a prompter for you to think about your situation relative to Part B. I am glad to review this GEP because there are not many Special Enrollment Periods (SEP’s) available to get you into Medicare Part B.

Thinking about Medicare and making decisions about Medicare can be confusing. Thank you for asking for clarification.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call us at 716-720-9797 or e-mail at SLM@lutheran-jamestown.org.